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NPI Code Detail

MEDICARE: PAUL JEFFREY WHITE PA-C

MEDICARE: PAUL JEFFREY WHITE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant2145GA

General Provider Information

NPI Number : 1205816964
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL JEFFREY WHITE PA-C
Provider Business Mailing Address
First Line : 3708 NORTHSIDE DR
Second Line :
City : MACON
State : GA
Zip : 31210-2404
Country : US
Telephone Number : 478-745-4206
Fax Number : 478-254-5463
Provider Business Practice Location Address
First Line : 3708 NORTHSIDE DR
Second Line :
City : MACON
State : GA
Zip : 31210-2404
Country : US
Telephone Number : 478-745-4206
Fax Number : 478-254-5463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 10/30/2025

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Directions to “ PAUL JEFFREY WHITE PA-C” Practice Location

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